Prepared For:
HIMSS AnalyticsMaturity Model OverviewNova Southeastern UniversityApril 11th, 2018
Presented by:Philip W Bradley, FHIMSSRegional Director North America
AGENDA
Who is HIMSS Analytics
What are the maturity models
Process and benefits of using the maturity models
himssanalytics.org
KEY POINTS
Governance
Data – The difference between Stage 6 & 7
Process Improvement
himssanalytics.org
Enabling better health through information & technology.
Healthcare Information and Management Systems Society (HIMSS)
HIMSS is a global, cause-based, not-for-profit organization focused on better health through information & technology
(IT). HIMSS leads efforts to optimize health engagements and care outcomes using information technology.
HIMSS Annual Conference, Corp Membership, Thought Leadership, etc.
Marketing Arm, Healthcare IT News, Local Forums, Content Creation & Syndication, etc.
LOGIC™, CapSite, Maturity Models, Insight & Research, Essentials Briefs, etc.
Who Is HIMSS Analytics
MATURITY MODELS
OTHER MODELS?Infrastructure Materials Management Security
Why Use a Maturity Model?
Learn from others experiences
Provides a roadmap
Helps convey a vision
Encourages everyone to work collectively
What is driving the Models?
In the US, a 1999 IOM report indicated more than 98,000 Americans die in hospitals each year as a result of medical errors
In the UK, the NHS experiences 40,000 deaths each year
These challenges are shared Worldwide
Problem has worsened
OR
has better data made it easier to identify errors
2016
What is really driving the Models?
Argentina, Australia, Belgium, Brazil, Canada, Chile, China, Denmark, Finland, France, Germany, India, Ireland, Italy, Malaysia, Netherlands, Portugal, Saudi Arabia, Singapore, Switzerland, Taiwan, Thailand, Turkey, UAE, UK, USA
Brazil, Canada, China, Saudi Arabia, Singapore, South Korea, Spain, The Netherlands, Turkey, UAE, USA
A Global Standard
Cross Regional EMRAM Score Distribution (2016 Q4)
Stage Asia Pacific Middle East United States Canada Europe
Stage 7 0.8% 1.3% 4.8% 0.2% 0.3%
Stage 6 5.5% 12.8% 30.5% 1.1% 2.5%
Stage 5 8.4% 22.8% 34.9% 3.7% 29.5%
Stage 4 1.6% 3.4% 10.2% 1.3% 6.7%
Stage 3 0.8% 16.8% 13.9% 31.4% 5.3%
Stage 2 31.9% 21.5% 2.3% 30.3% 34.5%
Stage 1 4.5% 6.0% 1.4% 15.0% 7.9%
Stage 0 46.5% 15.4% 1.9% 17.2% 13.3%
N = 794 N = 149 N = 5,478 N = 641 N = 1,462
Data from HIMSS Analytics® Database ©
A Global Standard
EMRAM
Some History of the EMRAM
Acute Care EMRAM
• Created in 2005
• To reflect a typical manner in which a hospital
progresses towards a paperless EMR
environment
– Academic vs. Community
• To “push the market” with a roadmap
• To inform government policy
Progressively sophisticated model …
A progressively
sophisticated
roadmap that
enables …
Quality, safety,
and
Operations
efficiencies
Process
• Stage 1-5 is self assessment using our online tool
– himssanalytics.org/emram
• Stage 6 is validated via a conference call in North
America with a HIMSS Analytics inspector
• Stage 7 is an onsite validation with three inspectors
– HIMSS Analytics expert
– A CMIO from another Stage 7 hospital
– A CIO or CNIO from another Stage 7 hospital
Stage 7 Validation Process
• Must have been validated at Stage 6
• Preliminary Call (60 minutes)
– With HIMSS Analytics to review the agenda and to
ensure the organization is indeed ready for the onsite
visit
– Review a “A Day In The Life Of A Stage 7 Visit”
• Technical Call (120 minute)
– Site reviews the technology used in security, disaster
recovery and business intelligence
• On-site Stage 7 Visit
Stage 7 Validation Process
On-site visit (about 8 hours)
• Opening Session w/ presentations by staff (90 min)
– System Overview & Pervasiveness of Use
– Governance
– Clinical & Business Analytics
– Health Information Exchange
– Disaster Recovery & Business Continuity
Stage 7 Validation Process
On-site visit (continued)
• Hospital Tour (Order determined by the hospital)
– Med/Surg floor
– NICU (if applicable)
– Medical Imaging
– Pharmacy
– Lab
– Blood Bank
– ICU
– ED
• HIM / Medical Records Office
• Team Deliberation
• Closing Session and results presentation
Hospital Presentation –System Overview & Pervasiveness of Use
• Pervasiveness of Use
– Show at least four months of data, and show it is “in control” – Inpatient only, but in use in the ED
• >90% CPOE
• >95% CLMA
• >95% Blood products
• >95% Human Milk
• >95% Specimen Collection
• >90% Doctors documentation using structured templates and capturing discrete information
• >90% of Nurse Order completed within 2 hours of schedule 90% of the time (not scored)
Hospital Presentation – Governance
• Best shown with an organization chart of committees
– Name and purpose of committee; reporting relationship
• Where / how are nursing needs accommodated?
• Where / how are medical staff needs accommodated?
• Show governance at work through examples
• Expect to see a role for:
– Medical Staff
– Quality Improvement leadership
– Pharmacy & Therapeutics
– Medical Informatics
– Nursing Informatics
– Infection Control
– Information Technology
Hospital Presentation – Governance
• Weak (may not be validated) if:
– Lack of organization chart
– Lack of clarity of reporting relationship
– Lack of examples of governance at work
– No strong sense of organization and mission
– There is a “sense” that it is an “IT project” and not an
enterprise effort at cultural transformation
• Need examples of “governance at work”
• Need examples of shared decision making
Common Stage 7 non-validation causes
• Not filmless in medical imaging
• CLMA only for a subset of patients or medications (e.g., not all medications are auto-identifiable)
• Paper
– Clinically relevant paper not scanned within 24 hours –consistently
– Handwritten order forms, flowsheets, warning sheets
• Lack of pervasiveness of use (e.g., fall below target goals, device integration not in all ICUs)
• Lack of Clinical Decision Support with orders & physician documentation
O-EMRAM
Progressively sophisticated model …
A progressively
sophisticated
roadmap that
enables …
Quality, safety,
and
Operations
efficiencies
A Few Differences betweenAcute Care and Outpatient EMRAMs
• Measure EMR Adoption where the encounter is patient and prescriber based (physician & / or licensed care giver who can asses, treat, generate orders & prescribe within the scope of practice laws)
• Stage 4 includes both CPOE and Physician Documentation, both with appropriate CDS
– Because documenting & ordering in the non acute setting is one simultaneous dialogue
• Stage 5 is Patient Engagement
– We expect to see the tools to enable patients to become actively involved with their health maintenance and chronic disease management
• Stage 7 Validation Visit
– We expect to see proof that patient engagement has delivered results
Process
• Stage 1-5 is self assessment using our online tool
– himssanalytics.org/emram
• Stage 6 is validated via a conference call in North
America with a HIMSS Analytics inspector
• Stage 7 is an onsite validation with three inspectors
– HIMSS Analytics expert
– A CMIO from another Stage 7 hospital
– A CIO or CNIO from another Stage 7 hospital
• On-site visit (about 8 hours)
• Opening Session w/ presentations by staff
• Clinic Visits
– Multiple diverse clinics (5 clinics minimum)
• If multi-specialty clinic, sample different specialties
• Order determined by the organization
• Medical Imaging, if in-house
• HIM
• Inspector Deliberation
• Closing Session and results presentation
Stage 7 Validation Process
Stage 7Opening Presentation by Clinic
• Hospital presents the following topics (90 minutes):
– System Overview & Pervasiveness of Use
– Governance
– Clinical & Business Analytics (focus on patient
engagement and population health)
– Health Information Exchange
– Disaster Recovery & Business Continuity
Clinic Presentation –System Overview & Pervasiveness of Use
• Present a diagram of overall clinical computing
environment
– We want to know what is not from your EMR vendor; where
are there interfaces?
– Can an order be generated outside of the EMR?
• If yes, who owns allergy information? – Must demonstrate
allergy reconciliation
• Pervasiveness of Use
– 95% CPOE – show at least four months of data, and show it
is “in control” – Aggregate of all clinics being considered for
the Stage 7 validation
Clinic Presentation –Governance
• Best shown with an organization chart of committees
– Name and purpose of committee; reporting relationship
• Where / how are nursing needs accommodated?
• Where / how are medical staff needs accommodated?
• Show governance at work through examples
• Expect to see a role for various clinic staff:
– Medical Staff
– Quality Improvement leadership
– Pharmacy & Therapeutics
– Medical Informatics
– Nursing Informatics
– Population Health Case Managers
– Information Technology
Clinic Presentation –Governance
• Weak (may not be validated) if:
– Lack of organization chart
– Lack of clarity of reporting relationship
– Lack of examples of governance at work
– No strong sense of organization and mission
– There is a “sense” that it is an “IT project” and not an
enterprise effort at cultural transformation
• Need examples of “governance at work”
• Need examples of shared decision making
Clinic Presentation –Health Information Exchange (HIE)
• This is a growing & dynamic area
• If there is no other entity able to transmit or receive
electronic exchange, we will not hold the client back
• We expect to see some effort
– We expect to see exchange outside of core vendor
• Explain what is being exchanged & with whom
– CCD, discrete data, bi-directional?
• Explain Public, Private, Current, Future exchange
efforts
• Is there local leadership from this client?
Case Studies
What about the other models?
Infrastructure – currently in development, used to measure an organizations IT stability and reliability
Material Management – currently in development, use to measure an organizations materials management solutions, including integration of consumables into the EMR
Security – not currently in development, intent would be to assess an organizations security profile
Ambulatory Examples
• Clinic A
– From 7% to 78% compliance on following asthma protocols
– 44% reduction in unnecessary admissions for diabetes patients through use of Patient Portal
– CHF patients supplied Blue-tooth enabled weight scales
• 42% reduction in annual admission rate
• Clinic B
– Patient submitted data in selected Dx, has cut 60 to 70 seconds per visit = $
– Patient self scheduling shows a 20% reduction in no-show rate
Patient Engagement & Reminders
• Childhood Immunizations: 70% to 89.7%
• Colorectal screening: 72% to 78%
• Tobacco cessation reminders: 54% to 97.4%
• A1C testing: 50% to 83%
• Diabetes Nephropathy testing: 78% to 92.6%
• Population Health Strategy
– Reduction of IP admissions per patient from 1.95 to 1.16
– Reduced ED visits per patient from 3.4 to 1.7
– Increased primary care provider visits per patient from 1.7 to 3.5
Value-Based Purchasing (VBP) Program*
Total
Performance
Score
Clinical
Performance
Score
Patient
Experience
Performance
Score
+ =
70% 30%
TPS “100” = High Value Performance
TPS “0” = Low Value Performance
*Program from U.S. Medicare to earn additional reimbursement
38.9
45.544.6
45.9 45.9
42.7
49.0
64.3
30.0
35.0
40.0
45.0
50.0
55.0
60.0
65.0
70.0
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
AV
G C
lin
ical
Sco
re
EMR Adoption Model Stage
Tipping Point
Value-based purchasing (vbp)
CAUTI Infections
30
20
4 0
5.34
4.47
1.08
0.000
10
20
30
40
50
60
0.00
1.00
2.00
3.00
4.00
5.00
6.00
# C
AU
TI
RA
TE
PE
R 1
00
0 C
AT
HE
TE
R-D
AY
S
# CAUTI CAUTI rate per 1000 catheter-days
Medication Administration Errorsper 1000 Adjusted Pt Days
0
0.5
1
1.5
2
2.5
0
5
10
15
20
25
Med
icati
on
Even
ts
Oth
er
Incid
en
t R
ep
ort
s
Other Incident Reports Medication Events
Source: HIMSS Analytics® Logic™
Financial Performance
The ChallengeMalnutrition is a significant problem in hospitalized patients. This is not a
new problem as a 1999 Institute of Medicine report focused on this topic
and nutritional screening within 24 hours of admission has been a JCAHO
requirement even prior to that time. However, malnutrition continues to be
the “skeleton in the hospital closet” (Butterworth, 1979) due to lack of
identification and intervention.
Resulting Value / ROIThis, this pilot cohort of 353 patients resulted in a total
opportunity of $1,285,536 in malnutrition-impacted
revenue (which translated to an additional allowable 340
days in the hospital).
Population Health
http://www.himssanalytics.org/case-study-list
Resulting Value / ROI The number of alerts per medication order and the number of
overridden alerts per medication order have decreased since early
2016, when we began implementing our program. We project that
due to these efforts, OSUWMC will achieve an annual reduction of
110,000 medication alerts and 1.76 million practice alerts
The ChallengeSeveral years after our big bang go live, we are continuously
working to optimize our system for clinicians and staff. A key
element of our ongoing success is the effort put forth by our
stakeholder groups, multidisciplinary workgroups designed to
evaluate and improve particular aspects of our electronic health
record (EHR). This case study describes how OSUWMC’s
Clinical Decision Stakeholder Group implemented a program to
reduce alert fatigue by identifying non-value added alerts and
reducing the alerts’ prevalence in the EHR.
Physician Productivity
Resulting Value / ROI We have done a formal study of the impact of these interventions.
The results are still preliminary but very promising. Some
highlights include: • A high water mark of 10,720 patient days
between transplant rejection episodes (our previous best was
7830 days). • Eight fewer transplant rejections compared to our
median rate. • Estimated dollar savings of $680,000 in hospital
charges (at a rate of $80,000 per rejection).
The ChallengeOur mission statement includes “Cincinnati Children’s will improve child
health and transform delivery of care through fully integrated, globally
recognized research, education and innovation. “ Although we had
implemented a clinical information system for inpatient in 2002, we did not
have a totally integrated system that could provide our institution with the
data and decision support needed for clinical care, research, and education
Patient Care
There are benefits to advanced EMR
capabilities… but the ROI requires “persistence
and patience”.o Be prepared for a medical staff satisfaction dip
o It appears to return to normal levels after two years
o Remember that huge age disparity
o Be prepared for nursing to hear the brunt of medical
staff dissatisfactiono What else is new?
o Nursing is IT’s ambassadors … make Nursing satisfied first
Work on the high touch AND high tech o EMR adoption is NOT just an IT department initiative…
it requires an Organizational Development orientation.
CONCLUSION
Enabling better health through information technology.
Q & A
Thank you